Older Persons Specialist Health Services

Overview

The majority of older people are well, living independently in the community. However, older people can suffer from multiple chronic illnesses, frailty, polypharmacy and other syndromes associated with ageing. Older people are more likely to require hospital care than younger people. Older patients with acute illness, complex needs and frailty benefit from specialist health services aimed at their unique needs. Disability and functional decline are associated with acute illness with increasing frequency with increasing age and multi-disciplinary rehabilitation is sometimes necessary. In Mercy University Hospital (MUH), we aim to provide a comprehensive specialist health service for ill older people in Cork.

Older with complex illnesses and deteriorating health benefit from specialist health services. The specialist health services for older people in MUH provide expertise in the clinical, rehabilitative, preventative and social aspects of illness in the older adult. We strive to take a comprehensive view of illness and disability in later life.

Our services for older people are made up of a number of the important elements overseen by a team of consultant physicians in geriatric medicine. The services are delivered by a gerontologically attuned multi-disciplinary team of doctors, therapists and nurses.

Geriatric Medicine

Geriatric medicine is one of the largest of all medical specialities. It is the branch of medicine that focuses on the healthcare of older people. Geriatric medicine is concerned with the specialist medical care of the frail older person. The speciality aims to promote health and to prevent and treat diseases and disabilities in older adults. Consultant geriatricians are highly trained consultant physicians. These consultants have significant expertise in disease of later life such as stroke, Parkinson's, Alzheimer's and heart failure, among many others. Consultant geriatricians have particular expertise in the diagnosis and treatment of acute illness in older people where clinical presentation can be non-specific and sometimes atypical. They are highly trained with skills in the diagnosis and management in syndromes of frail older people such as falls, acute confusion, mobility disorders or incontinence.

History in Brief

Geriatric medicine is a 'very young' medical speciality in Cork and particularly in Mercy University Hospital. Geriatric medicine began as a speciality in Cork city in 1969 with the appointment of Dr. Michael Hyland to St. Finbarr's Hospital. However, it was not until 2002 that geriatric medicine had a specialist base in MUH following the appointment of Dr. Colm Henry as consultant physician in geriatric medicine and with the opening of St. Mary's Ward, an acute admissions unit for older people.

Between July 2003 and November 2011, a sister unit operated in the South Infirmary-Victorial University Hospital (SIVUH) providing medical rehabilitation services for frail older people from both MUH and SIVUH. Following reconfiguration of some services in 2011, the inpatient rehabilitation component of our services is provided from St. Finbarr's Hospital.

Our department collaborates closely with the department of geriatric medicine in Cork University Hospital to provide a city-wide service for older people.

In the relatively short time since 2002, specialist services for older people have developed significantly here. We now have three whole-time equivalent consultants in geriatric medicine working in the department and have developed significant gerontological nursing expertise. We continue to develop gerontologically attuned multi-disciplinary teams throughout the hospital -- both general geriatric outpatient and sub-speciality outpatient services have been developed. In February 2012, Cork city's first acute stroke unit became operational in MUH following collaboration between geriatric medicine and neurology.

We hope to further develop comprehensive specialist services for older people in the coming years.

Multi-Disciplinary Assessment and Management

The essence of our service is to assess and treat the medical and rehabilitative needs of older people. This is achieved through comprehensive geriatric assessment. The evidence base demonstrates that outcomes for older people with multiple pathologies and functional problems are improved if they are managed by an inter-disciplinary team led by a consultant geriatrician.

The approach within our service is inter-disciplinary. This is reflected by the input of many different disciplines into patient care. The nursing staff on St. Mary's Ward (acute medical unit for older people) are specialist in nature and led by CNM2, Ms. Sharon Maher. There is dedicated physiotherapist and occupational therapist involvement on this ward with input from our dieticians, and speech and language therapists.

Specialist Gerontological Nursing

The role of the clinical nurse specialist in Gerontology is to provide initial person-centred care and ongoing management of complex cases, medical issues and further rehabilitation to the older patients admitted to MUH. The gerontology nurse specialist (GNS) provides a service to all wards, emergency department and acute medical unit, developing practice, providing expert skills and knowledge and offering support where needed. The GNS is a resource for all staff, colleagues, as well as patients and their families, offering expert specialist advice, education, expert knowledge and support. The GNS plays an important role in the development of projects that will enhance care for the older persons, appropriate patient assessments and early patient discharge planning by working with all inter-disciplinary team members.

What We Do

Our service comprises of a number of components and operates across a number of sites: Mercy University Hospital, St. Finbarr's Hospital and a number of community hospitals. Components of our service include:

St. Mary's Ward

St. Mary's Ward is a dedicated specialist ward for frail older people in Mercy University Hospital (MUH). It is an acute medical admissions ward for older people. Many patients on St. Mary's Ward are admitted directly to the ward from the emergency department and sometimes from other departments following a consultation, if a bed is available. The approach on the ward is inter-disciplinary and is reflected by the input of many different disciplines into patient care. The nursing staff are specialist in nature and led by CNM2, Ms. Sharon Maher. There is also dedicated physiotherapist and occupational therapist involvement, and input from our dieticians, and speech and language therapists. Furthermore, we liaise closely with social workers and discharge coordinators.

Stroke Care

Mercy University Hospital (MUH) has a long history of acute stroke care as part of the long established acute medical services it provides. In recent times, specialist services for stroke have developed in MUH. Since 2007, consultant colleagues in geriatric medicine and neurology have provided a 24 hour/day, 7 days/week stroke thrombolysis (clot-busting) service.

In 2011, MUH was designated as one of the acute stroke sites by the Health Service Executive (HSE) National Clinical Care Programme in Stroke. This national programme aims to provide rapid access to the best-quality stroke services throughout the country.

Acute Stroke Unit

In February 2012, Cork city's first acute stroke unit became operational in MUH. The designated unit is located on St. Joseph's Ward. This unit is the hub of the comprehensive stroke service provided by MUH. The unit provides a co-ordinated high-quality multi-disciplinary care including physiological monitoring, neurological monitoring and rapid treatment of stroke. Stroke-associated complications are treated within the unit. The multi-disciplinary team initiate early rehabilitation and secondary stroke prevention measures for all patients.

Through the national clinical programme in stroke, MUH appointed a stroke clinical nurse specialist and also an occupational therapy specialist for stroke. Along with geriatric medicine and neurology medical colleagues, they work with our broader multi-disciplinary team (including nursing and support staff on St. Joseph's Ward, speech and language therapy, physiotherapy, clinical nutrition and social work) to run the stroke unit.

The MUH stroke unit is part of the city-wide service for stroke. We work closely and co-ordinate with the 'Stroke Rehabilitation Unit' in St. Finbarr's Hospital and the 'Acute Stroke Unit' in Cork University Hospital.

Stroke Unit Care

Stroke unit care is the single biggest factor that can improve a person's outcomes following a stroke. An acute stroke unit consists of a discrete area of a hospital that exclusively or principally takes care of stroke patients and is staffed by a specialist multi-disciplinary team.

There is overwhelming evidence that stroke units reduce death and increase the number of independent and non-institutionalised individuals. The provision of acute stroke units in hospitals reduces death and dependency rates from stroke by over 20 percent. Successful stroke units are built around a stroke-skilled multi-disciplinary team that is able to meet the needs of the individuals.

What is a Stroke?

A stroke occurs when the blood supply to part of the brain is cut off or severely reduced, depriving the brain of oxygen. A stroke is caused either by a blockage of a blood vessel supplying blood to the brain (cerebral thrombosis) or a bleed into the brain from a burst blood vessel (cerebral haemorrhage). Within minutes, brain cells begin to die.

What is the Impact of a Stroke?

Stroke is an illness with a huge personal and societal impact. Stroke is the most common cause of acquired physical disability. Stroke kills more people in Ireland than lung cancer, bowel cancer and breast cancer combined. Approximately 10,000 people experience stroke every year in the Republic of Ireland.

The effects of stroke can range from very mild to severely devastating. Strokes affect different people in different ways, depending on the type of stroke and the area of the brain affected. Paralysis with weakness on one side of the body is a common after-effect. Brain injury from a stroke can affect the sense of seeing and feeling, the ability to speak and understand speech, and less commonly behavioural patterns, thought patterns, memory and emotions.

Mercy Older Person Assessment and Liaison (MOPAL) Service

Older people (>65 years old) constitute approximately 12% of the population in the southern region but account for ~50% of acute medical admissions. In this regard, Mercy University Hospital is no different than other hospitals in the region. Many older people are admitted under other general medical and surgical services. The Mercy Older Person Assessment and Liaison (MOPAL) service is the focus of our consultation service in the hospital.

Older people are more likely to have multiple co-morbidities and complex needs. They are also increasingly likely to have a frailty syndrome and are therefore at increased risk of prolonged hospital stays without the appropriate multi-disciplinary assessment. The MOPAL service aims to identify frail older people, their needs and implement a comprehensive multi-disciplinary assessment without delay.

Team

For contact information, please see the Consultant listing on this website.

Other Medical Staff

In the department of geriatric medicine there are medical registrars, specialist registrars, senior house officers (SHO) and interns (functioning between MUH and St. Finbarr's Hospital).

The department functions as a training department for both basic specialist training and higher specialist training in general internal medicine and geriatric medicine for the Royal College of Physicians of Ireland (RCPI). There are numerous and on-going learning opportunities for specialist registrars, registrars, SHO's and interns. Both clinical and non-clinical skills can be developed. There are also opportunities to gain skills in the area of research within the department.